Severe Multiple Sclerosis Relapse After COVID-19 Vaccination: A Case Report

Abstract

We describe a case of acute relapse in a woman with Multiple Sclerosis (MS) shortly after the mRNA COVID-19 vaccination. The patient received a diagnosis of MS in November 2016 at the MS Centre of the A. Cardarelli Hospital (South of Italy). Since that moment, her clinical conditions and pharmacological therapies have been managed at this MS centre where, according to national recommendations, in April 2021, the patient received the BNT162b2 vaccine. Almost 48 h after receiving the vaccine, the patient developed paraesthesia and weakness in her left arm and limbs. The neurological examination revealed walking difficulties while the MRI showed three new voluminous enhancing lesions. After having received methylprednisolone iv for 5 days, the patient's neurological symptoms fully recovered. Along with the implementation of COVID-19 vaccination programmes among vulnerable population, further studies are needed in order to improve our knowledge on the benefit/risk ratio of COVID-19 vaccines.

New diagnosis of multiple sclerosis in the setting of mRNA COVID-19 vaccine exposure

“…This association warrants further systematic investigation, as COVID-19 vaccination, and in our cases mRNA vaccination, appears to be associated with inflammatory MS disease activity. In real-world safety reports based on MS, MOG antibody disease, neuromyelitis optica spectrum disorder, and transverse myelitis populations (963 patients), exposure to Pfizer-BioNTech COVID-19 vaccine has been associated with new or worsening neurological symptoms in less than ~15% of patients, commonly occurring early in the post-vaccination period (<7 days), and mostly self-resolving within 2 weeks ( Lotan et al, 2021a ; Lotan et al, 2021b ), Although there is evidence of immune activation with vaccines leading to other neuroimmunological disorders such as Guillain-Barré Syndrome, acute disseminated encephalomyelitis, or transverse myelitis, this has not been the case for MS. ( Stone et al, 2019 ; Agmon-Levin et al, 2009 ) Despite broad use of mRNA COVID-19 vaccines, there have been few reports of MS flares in the short-term post-vaccination period as well as optic neuritis and transverse myelitis ( Maniscalco et al, 2021 ; Kaulen et al, 2021 ). A cohort of 555 MS patients receiving at least one dose of Pfizer-BioNTech mRNA COVID-19 vaccine did not experience an increase in relapse rate as compared to the unvaccinated population ( Achiron et al, 2021 ).…”

Case Report: Multiple Sclerosis Relapses After Vaccination Against SARS-CoV2: A Series of Clinical Cases

“…Only two cases of acute relapse after COVID-19 vaccination have been reported so far (13,14), both having a good outcome.…”

Multiple Sclerosis Relapse Following COVID-19 Vaccination: A Case Report and Literature Review

“…Maniscalco et al reported a case of MS relapse after the messenger ribonucleic acid (mRNA) COVID-19 vaccine. The patient reported weakness and paresthesia after 48 hours of the first dose of vaccine and responded well to methylprednisolone [9].…”